Fetal surgery (Centre for Prenatal Therapy) 

The fetal surgery service is run and supported by the fetal medicine unit, neonatal neurological surgery and anaesthetists. They are supported by obstetricians, trainee doctors, midwives and administrative staff.

All parents will have access to counselling and support services when making decisions about whether to proceed with fetal surgery.

Mothers who have fetal surgery for their baby with spina bifida will be able to go home afterwards. They can return to UCLH for delivery or decide to deliver their baby at their local hospital. Their child will then be followed up at Great Ormond Street Hospital or their nearest spina bifida unit.

Mothers who have FETO for their baby with congenital diaphragmatic hernia will be asked to stay in accommodation provided close to the hospital in case of early labour. Again, once their child is born, he or she will be followed up at Great Ormond Street Hospital.

  • Conditions treated

  • Prenatal Therapy and Fetal Surgery

    New options for treating structural diseases of the fetus.

    The multidisciplinary team consists of fetal medicine specialists and obstetricians, fetal and paediatric surgeons, obstetric anaesthetists, fetal medicine midwives and theatre staff who together are introducing new fetal treatments to the UK. Fetal surgery is one of these and it is currently available in a limited number of centres around the world.

  • Twin pregnancy complications

    Twins and triplets are more likely to be born early and need special care after birth than single babies. At UCLH we have a dedicated multidisciplinary team (MDT) that offers individualised care for pregnant women and their families when expecting twins, triplets or more. We are a regional and national referral centre for multiple pregnancy complications such as twin to twin transfusion syndrome (TTTS). We strive to provide the highest standard of care and information in a calm and supportive environment.

    TTTS is a condition that affects MC twins. The common placenta may be shared unequally by the twins and one twin may have a share too small to provide the necessary nutrients to grow normally. The other twin may have a very big share which results in an overload with blood that could lead to cardiac failure and also causes this baby to have too much amniotic fluid (polyhydramnios).

    If your twins are found to have TTTS you will be offered a treatment called laser ablation. During this procedure, vessels that are found to communicate between the twins are then coagulated using a laser beam.

  • Spina Bifida

    Spina bifida (myelomeningocele, MMC) is a condition that arises before birth where the spinal column and spinal cord are not properly formed. Traditionally the defect is closed using surgery shortly after the baby is born. Recent studies have shown that the defect can now be closed by operating on the baby before birth (fetal surgery).

    Evidence shows that in selected cases open fetal surgery to close the spina bifida defect improves baby outcomes compared to surgery after birth. There are only a few centres in the US, South America and Europe where this type of fetal surgery is performed. Open fetal surgery involves making a small opening in the uterus (hysterotomy) in mid-pregnancy to access the fetus and close the spina bifida defect. Fetal surgeons then close the uterus allowing the baby to continue to grow for the rest of the pregnancy. Our multidisciplinary team at UCLH has secured the clinical permissions to offer the first open fetal surgery service of this kind in the UK.

  • Congenital Diaphragmatic Hernia (CDH)

    The diaphragm is a curved muscle that separates the contents of the chest from the abdomen. In babies with congenital diaphragmatic hernia (CDH) the diaphragm does not form completely during fetal development, leaving a hole. This hole allows part of the intestine (gut) to move into the chest, which can squash the lungs and can stop them developing properly before birth.

    Traditionally the hole in the diaphragm is repaired just after birth. Fetal tracheal occlusion or FETO is a technique that temporarily places a balloon in the baby’s airway which in selected cases allows the lungs to develop before birth. UCLH is now offering FETO for selected cases of CDH. Where the hole is on the right side of the diaphragm, studies suggest that this may improve baby outcomes.

    UCLH is also participating in the TOTAL trial (Tracheal Occlusion To Accelerate Lung growth) to find out if FETO improves outcomes for babies with a left-sided CDH. We are grateful to CDH-UK charity for funding the occlusive balloons for the trial.

    The Centre for Prenatal Therapy clinical service is funded by Great Ormond Street Children’s Charity and UCLH Charity

 Consultants

Prof Donald Peebles, Consultant in Obstetrics and Fetal Medicine

Prof Donald Peebles

Professor Donald Peebles is the Clinical Director for the UCLH Division of Women’s Health (2015 - present) and is a consultant in obstetrics and fetal medicine. He provides a range of diagnostic and therapeutic services on the Fetal Medicine Unit (FMU) with particular interests in the management of fetal growth restriction, fetal rhesus disease and disorders of fetal brain development.

Donald has a number of research interests that focus on improving the outcomes for women and their babies following complicated pregnancies. He is the president of the Blair Bell Research Society, the showcase for British research in obstetrics and gynaecology as well as a member of the Academic Committee of the Royal College of Obstetricians and Gynaecologists. In 2013 he was appointed as co-clinical lead for the NHS England London Maternity Strategic Clinical Network.

Donald is a faculty member of the Infection, Inflammation and Immunity Theme of the NIHR UCLH Biomedical Research Centre.

Email: Donald.Peebles@uclh.nhs.uk 

Full consultant profile

Mr Pranav Pandya, Consultant in Fetal Medicine

Mr Pranav Pandya

Mr Pandya is a consultant in fetal medicine and has been an honorary senior lecturer at UCLH since 2000. He is currently the director and clinical lead of fetal medicine services at UCLH.

Mr Pandya is dedicated to caring for pregnant women and in particular the well-being of their baby. His expertise is in the ultrasound examination of the mother and unborn baby(s) with particular interest in first trimester anomalies, fetal cardiology, surgical anomalies, renal anomalies and fetal therapy. He has done extensive research into screening for fetal aneuploidy and fetal medicine.

Mr George Attilakos, Consultant in Obstetrics and Fetal Medicine

Mr George Attilakos

Mr Attilakos is the lead clinician for the Maternal Fetal Assessment Unit (MFAU). In addition to looking after single pregnancies, Mr Attilakos specialises in looking after complicated and uncomplicated multiple pregnancies.

He has a special interest in Postgraduate Medical Education and is the RCOG College Tutor for UCLH. He has co-developed a national course for teaching operative birth skills to junior obstetricians.

Full consultant profile

Prof Anna David, Consultant in Obstetrics and Fetal Medicine

Prof Anna David

Professor David offers a range of diagnostic and therapeutic services in the Fetal Medicine Unit (FMU). She specialises in cases where the baby has a structural anomaly, a genetic condition or when the baby’s growth is poor (fetal growth restriction).

She has close links with the talented UCLH neonatal team that are expert in caring for the smallest preterm infants. Professor David set up the Preterm Birth Clinic at UCLH which is now one of the busiest in the UK, providing continuity of care in a nurturing environment. The comprehensive service offers pre-conceptual counselling, a wide range of cerclage and other treatments and predictive tests.

Prof Jan Deprest, Consultant

Jan Deprest is a leading international fetal surgeon who works two days a week at UCLH as a Consultant and at UCL as a Professor of Obstetrics and Gynaecology. At UCL he works in the Institute for Women's Health and the Translational Imaging Group. His home institution is at the Katholieke Universiteit Leuven and its University Hospitals Leuven (Belgium). Prof Deprest is currently the academic chair of the Department of Development and Regeneration and director of the Centre for Surgical Technologies.

Click here to view full consultant profile

Mr Ruwan Wimalasundera, Consultant in Obstetrics and Fetal Medicine

Mr Ruwan Wimalasundera

Mr Wimalasundera is considered one of UKs leading specialists in the management of multiple pregnancies. He manages both low and high risk pregnancies and specialises in the management of multiple pregnancies including complicated monochorionic pregnancies and runs the multiple pregnancy service.

He particularly specialises in the management of twin to twin transfusion syndrome (TTTS) in monochorionic twins; using fetoscopic laser ablation to placental vessels. He receives referrals from all over the UK for this treatment.

Mr Wimalasundera encourages the natural management of pregnancies, but also offers the option of a natural caesarean section when it is appropriate.